Assessment of current burden of human rabies in Sir Ronald Ross Institute of Tropical and Communicable Diseases (SRRIT&CD) – Five year study

Abstract

Human rabies has been still endemic in India. There are an increasing number of studies estimating the burden of human rabies, but the true incidence of the disease and endemicity were rarely reported in the literature. The main objectives of the present study were to determine the endemicity and to estimate the current burden of human rabies in and around Sir Ronald Ross Institute of Tropical and Communicable Diseases (SRRIT & CD), Nallakunta, Hyderabad. All cases admitted at SRRIT & CD with signs and symptoms of rabies were studied during the period of January 2009 and December 2013. The annual incidence of human rabies in this hospital was estimated to be 152. It is endemic mainly in urban areas that include many areas in Hyderabad and Secunderabad and also adjacent districts. The majority of the patients were children and adult male, from urban areas, and had not taken post exposure prophylaxis (PEP) i.e. wound care, active immunization (ARV) and passive immunization (RIG). The main animals responsible for bites were dogs (99%), most of which were stray and the most common bite sites were the extremities. Most common clinical feature was hydrophobia. About 92.76% of these patients had not taken PEP. Human rabies continues to be a dreadful disease in India and the dogs are the principal reservoir, mainly stray dogs. This study provides strong evidence that human rabies is still an endemic disease even in urban areas. This is mainly due to lack of awareness about proper PEP. Improved coverage with modern rabies vaccines, control of rabies due to dogs and other animals and intensifying public education about the disease play main role in the reduction of the disease.

A comparative study between propofol and thiopentone for hemodynamic parameters during induction of general anesthesia in surgical patients

Abstract

Hemodynamic stability is very much important during induction of general anesthesia. So, this study was planned to compare hemodynamic parameters during induction by thiopentone and propofol. This prospective study was conducted after approval from institutional ethics committee in non-hypertensive patients of ASA grade I and II aged between 18-60 yrs of either sex, admitted for different surgical procedure. The patients were randomized into group P (propofol) and group T (thiopentone). Heart rate, both systolic (SBP) and diastolic blood pressure (DBP) were recorded during induction and at 1 minutes, 2 minutes, 3 minutes and 4 minutes interval after intubation. Thirty patients in each group were included during study period. After induction, there was fall in both mean SBP and DBP after an increase during intubation which was more in group T (p˂0.05). The statistically significant difference was observed only at 1min between two groups for SBP (P value <0.05). The mean heart rate was almost similar at pre induction time in both the groups (p>0.05). There was rise in heart rate during intubation in both the groups, thereafter heart rate started decreasing. The fall was similar in both the group at any given point of observation (P value >0.05). Both propofol and thiopentone alter the blood pressure and heart rate during induction in surgical patients which are more pronounced in thiopentone but these changes return close to baseline value earlier in case of propofol. So, propofol could be the preferred inducing agent in hemodynamically unstable patients.

Abstract

In this study, we investigated for the first time the antihyperlipidemic ef-fects of crude extract of stigmas from Crocus sativus (saffron) against hyperlipidemia induced by tartrazine (synthetic dye) in normal male rats. Thirty adult male albino rats weighing about 150 - 200 g, were divided into 5 groups (n = 6) and daily treatment was given orally. Clinical biochemis-try and metabolic parameters were evaluated at the end of the experiment and after 105 days. (n=6, for all groups). Our data revealed that the meta-bolic parameters like consumption of food and water, pH and urine vol-ume have not been affected; also the difference between liver, right kid-ney and heart weight was not significant. The levels of cholesterol and triglyceride were significantly increased in group 2 and group 3 compared to control group. There was no significant difference in the level of cholesterol and triglyceride in group 4. Treatment with saffron alone did not have any significant effects on the level of fat compared to control group. The oral administration of the crude extract of saffron revealed good hypolipidemic effects in adult male albino rats. These results suggest that aqueous saffron extract reduced plasma cholesterol and decreased triglyceride. Therefore, it could conceivably lead to suitable changes in blood lipid profiles.

Effect of viral hepatitis E on maternal and fetal outcome

Abstract

Viral hepatitis in pregnancy has been a subject of continuing interest. It is a major cause of enteric transmission of non A and non B hepatitis and is usually self limiting. However in pregnant women, it is more severe. This prospective study was conducted in the department of obstetrics and gynecology, Liaquat University of Medical and Health Sciences, Jamshoro from May 2013 to July 2014 to know the frequency and outcome of women with hepatitis E virus (HEV) infection. Among the women with jaundice, sixty eight pregnant women were selected as cases and 16 non pregnant women were selected as control and a comparative study was done. Blood sample were taken at the beginning of the pregnancy and in the postpartum period. Serology was done for HEV and other tests included blood picture, hepatic and kidney function tests. All women underwent ultrasound examination. Hepatitis E was found in 77.9% of pregnant women and 25% in non pregnant women. The commonest age group was between 21-25 years. The liver function test and renal function test were not significantly different in the two groups. No virus was detected in 9 (13.2%) cases and 8 (15%) control. The maternal mortality was 19.1% in cases. The fetal loss was found in 42.6% of cases. Pregnancy with hepatitis E is associated with adverse maternal and fetal outcome.

Abstract

We report a case of massive left sided hemorrhagic effusion secondary to pancreaticopleural fistula (PPF) in a young, previously healthy female of 17 years. High pleural fluid amylase levels prompted us for evaluation of this uncommon cause. Computed tomography (CT) of thorax and abdomen and magnetic resonance cholangio-pancreatography (MRCP) confirmed the diagnosis of PPF. Patient was managed with intercostal drainage of pleural effusion and therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) with stenting of the pancreatic duct. Patient recovered completely and is doing well after one year of follow up without any recurrence of pleual effusion. Thus, high index of suspicion, and measurement of pleural fluid amylase, especially in large and or recurrent (left sided) pleural effusions, will help in early and definitive diagnosis of PPF. Above approach with therapeutic ERCP would cure this condition with less morbidity. Advances in the latter techniques dramatically reduced the need for surgical interventions and prolonged hospital stay with conservative treatment approach.

Abstract

Thromboembolism is a rare extra-intestinal manifestation of inflammatory bowel disease. Thromboembolic event involving CNS in a case with inflammatory bowel disease (IBD) is very rare & leads to increase in mortality. The mortality of ulcerative colitis with thromboembolic complications have been reported to reach 25 percent. Here, we present a case of a young adult with a two years old history of ulcerative colitis with a sudden onset of stroke with no other associated co-morbidities for cerebrovascular disease.

A case of Bochdalek hernia in adult misdiagnosed as pulmonary tuberculosis

Abstract

Bochdalek hernias are congenital defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Usually it manifests in the neonatal period and occasionally in childhood. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. Patients are initially investigated and treated for other diseases, therefore diagnosis is purely incidental. Herein, we are reporting a case of symptomatic Bochdalek hernia in an 18-year-old female misdiagnosed as pulmonary tuberculosis and treated accordingly, but with no improvement. This case illustrates importance of high index of clinical suspicion and role of computed tomography in avoiding misdiagnosis and occurrence of serious complication if not treated early.

Abstract

Autologous blood withdrawal before instituting cardiopulmonary bypass (CPB) protects the platelets, preserve red cell mass and reduce allogeneic transfusion requirements. Ideal condition for autologous blood donation is elective cardiac surgery where there is a high probability of blood transfusion. The purpose of this study was to assess the role of preoperative autologous blood donation in cardiac surgeries. Out of 150 patients registered, 50 cases were excluded on the basis of hemoglobin content (<11 gm/dl) and age group (pediatric group); therefore, the study was conducted on 100 cardiac surgery patients. We collected 13% to 15% of patient’s estimated blood volume in bags containing either heparin or citrate phosphate dextrose (CPD) and stored at room temperature. This was later returned to the patient through a peripheral vein after the bypass. In most of the cases 1-2 units (1 unit=450 ml) were withdrawn and re-administered to the patients. This study showed that there was 10% decrease in banked blood requirements. We conclude that autologous pre-donation is a promising alternative in reducing the harmful effects of allogeneic blood transfusion in elective cardiac surgery. It improves the recovery profile and decreases the transfusion related morbidity.

Abstract

This study aimed to assess the prevalence and magnitude of stress in Saudi undergraduate medical students and its associated socio-demographic factors using a cross-sectional design. It was conducted at King Khalid University Medical College during September-October 2016, including 267 students of both sexes and all study levels. Data was collected using an anonymous self administered questionnaire including socio-demographic information like participant details and family details, along with the Kessler -10 scale for measuring stress. Data analysis was carried out using SPSS 17.0. Results were described as frequencies, percentages, mean±SD. Independent samples t test and ANOVA were used to study the relationship of stress with various social and demographic factors. A mean stress score of 23.46±7.77 was observed. This is graded as mild stress according to Kessler scale classification. Forty four students, i.e. 16.5% reported perception of high stress, while 23.6% students perceived mild and 26.6% reported moderate stress. Students who perceived no stress comprised one third (33.3%) of the study population. A significant relationship of female gender with stress was observed (p˂0.0001). It was concluded that most of the medical students undergo some degree of stress during their study period and female students have significantly more stress than their male counterparts.

Abstract

The cardiovascular diseases (CVD) are showing increasing trend particularly in developing countries. Deranged lipid metabolism is the most common risk factor for development of CVD. Many established drugs are used for the management of dyslipidemia but have side effects; therefore there is need to evaluate medicinal plants for possible lipid lowering activity since they are less toxic. Food substance like Soy bean (Glycine max) has been reported to have useful therapeutic effects on heart disease. This study was designed to determine the effect of crude methanol seed extract of Glycine max (MEGM) on the serum lipid profiles of ad-libitum high-cholesterol-fed male albino wister rats. A total of twenty (25) male rats were used and were randomly assigned into five groups namely A, B, C, D and E of five animals in each group. All rats in groups A-D were given high cholesterol diet, HCD (2000mg/kg) once daily for two weeks. In addition, rats in group A and B received crude methanol seed extract of Glycine max once daily at a dose of 400mg/kg and 200mg/kg respectively for two weeks. Group C received atorvastatin 20mg/kg for two weeks and this served as the positive control. Group D served as negative control and received neither the extract nor drug. Group E served as normal control. The biochemical parameters of lipid profile: Total cholesterol (TC), High density lipoprotein (HDL-C), Low density lipoprotein (LDL-C), Very low density lipoprotein (VLDL), and Triglycerides (TG) were assayed. The levels of TC, LDL, TG and VLDL were highly elevated significantly in the affected group (HCD alone) when compared with normal control (p˂0.001). Administration of high dose MEGM (400mg/kg), low dose MEGM (200mg/kg) and atorvastatin (20mg/kg) separately in the presence of HCD challenge significantly lowered the elevated levels of TC (p˂0.05), LDL (p˂0.001), TG (p˂0.01) and VLDL (p˂0.01) when compared to the affected group. Furthermore and worthy of note, the levels of HDL was significantly reduced in the affected group (HCD alone) in comparison with normal control (p˂0.01); however the administration of high dose MEGM (400mg/kg) and low dose MEGM (200mg/kg) separately in the presence of HCD challenge significantly increased the reduced HDL levels (p˂0.001 and p˂0.05; respectively) when compared to the affected group. Glycine max has anti-hyperlipidemic effect on the hyperlipidemic rats and possesses cholesterol lowering property.

Falciparum Malaria associated changes in biochemical indices in children

Abstract

Metabolic disturbances associated with fluid and electrolyte imbalance, and changes in the synthetic functions of the liver are common complications of malaria and are dependent on the degree of parasitemia. Packed cell volume (PCV), random blood glucose (RBG), total bilirubin (TB), total proteins (TP), albumin, serum electrolytes [sodium (Na+), potassium (K+), chloride (Cl-), bicarbonate (HCO3-), calcium (Ca2+), magnesium (Mg2+)] and anion gap (AG) were determined in fifty children with malaria aged between 1-15 years and thirty age matched apparently healthy children without malaria, using colorimetric and flame photometric methods. Data was analyzed using t-test at p < 0.05. The PCV, RBG, Na+, Mg2+, AG and TP were significantly lower and Ca2+ and TB higher in children with malaria compared to children without malaria. The serum Na+, K+, AG, TP and albumin were significantly lower and Ca2+, HCO3- and TB higher in children with severe malaria compared to those with mild malaria. Malaria and high parasite density is associated with perturbations in homeostasis of proteins and electrolytes and these may be implicated in the deleterious consequences associated with malaria in children.

Abstract

Hypercalcemia is a clinical condition with an abnormally high serum calcium (Ca) level. Hypercalcemia is associated with many diseases with primary hyperparathyroidism and some malignancies accounting for greater than 90% of cases. Hypercalcemia may be clinically useful as a diagnostic or prognostic marker for these diseases. This paper covers the various etiologies attributing to hypercalcemia, pathogenesis and the differential diagnosis of hypercalcemia. Hypercalcemia is a useful diagnostic marker in hypercalcemia-related diseases such as primary hyperparathyroidism, malignancies and granulomatous disorders. Adequate managements or treatments are aimed to reduce serum Ca levels by preventing bone resorption, enhancing urinary Ca excretion, or preventing intestinal Ca absorption. The optimal choice is dependent on the cause and/or severity of hypercalcemia. Drug treatment or management of hypercalcemia include: Bisphosphonates, Gallium nitrate, Glucocorticoids and Denosumab.

Bilateral pleuropulmonary blastoma (PPB) in a 2-year-old girl: A case report with review of literature

Abstract

Pleuropulmonary blastoma (PPB) is a rare aggressive malignant tumor of infancy and early childhood accounting for 0.25-0.5% of primary lung tumors. PPB is a dysontogenic tumor composed of immature malignant epithelial and/or mesenchymal tissues whose features may resemble early embryological lung tissues. It is the pulmonary analog of other tumors of childhood including Wilms' tumor, neuroblastoma, hepatoblastoma, pancreatoblastoma and retinoblastoma. Morphologically, PPB has three types (I, II, and III). A fourth type (Ir) was added in 2006 by PPB registry. Type II and III are very aggressive malignancies with metastatic potential. Bilateral PPB is very rare. To the best of our knowledge, only two cases of bilateral PPB have been reported. No cases of bilateral PPB have been reported from India. Herein, we are reporting a case of bilateral PPB (type II) in a 2-year-old girl who presented with cough, dyspnea and mild fever for past 4 months. She died few days after admission.

The use of insulin for early diagnosed patients with type 2 diabetes mellitus in primary health care in Indonesia: a general practitioner’s perspective

Abstract

Indonesia, one of the greatest population countries, contributes a significant increase of global prevalence of type 2 diabetes mellitus. The need of insulin treatment is significantly rising as many cases do not meet the recommended glycemic target with oral glycemic lowering drug (OGLD). However, there is a discrepancy between guidelines issued by the Ministry of Health of Indonesia through national formulary and the Indonesian Medical Council through Indonesian medical standard of competency. Here, we described our point of view about the situation of diabetes mellitus in Indonesia, a matter of insulin availability in public health centre, and recommendations to solve this issue.